In the past few days, Americans (and I am sure many people around the globe) have read Angelina Jolie’s startling announcement that she recently underwent a preventative double mastectomy and reconstructive surgery (and as I understand she will also have her ovaries removed). Like most people, I was awestruck by her bravery, her straightforwardness, and her honesty. As a scholar of medicine and gender and women’s history, I was instantly struck by how her melodic narrative described her agency as both a patient and a woman. Her op-ed also conveyed a dream of perfect medical care, family support, and clarity in making a very profound decision that would have a major impact on her future health. But as much as I marveled at her decisions (as did so many other individuals), my academic training immediately brought a level of cynicism that I could not easily dismiss (and I am not alone). I almost instantly began to think about Angelina Jolie the celebrity, not Angelina Jolie the common woman. Her status and privilege allowed her to have what seemed to be an almost ideal experience under the circumstances, or what I like to call the Jolie Treatment, which the Pink Lotus Breast Clinic has showcased on their website. Pink Lotus and Jolie obviously see her experience as a way to educate women to the options available to prevent or treat this horrible disease. Jolie will undoubtedly become a spokesperson for breast cancer prevention, and to be honest, I can think of no one better suited to bring this message to thousands of women. But what the Jolie Treatment ignores or downplays to a considerable minimum is that celebrity healthcare is expensive. If Jolie is going to take the lead, then she has to concede and even battle against the disparity between wealth and health in the U.S and the profound impact this has on women’s healthcare.
Public acknowledgement of celebrities and their battles with various illnesses is not new. Barron H. Lerner discussed this connection extensively in When Illness Goes Public: Celebrity Patients and How We Look at Medicine, which is a fascinating account of how the general public learns about medicine through celebrities’ experiences with particular diseases. He traces how celebrities’ health and illnesses can fuel interest and impart knowledge while also raising fears, changing perceptions, and creating myths about particular diseases and treatments. For the most part, celebrities bring a positive light to illness and create support and advocacy for treatment. But what is missing in most, if not all, of the celebrity accounts, whether successful or not, is the cost associated with illness.
The cost of medical care has been a concern in America since the early twentieth century. As medicine advanced, its prices rose. Doctors and reformers worried that good medical care was out of reach for many Americans. The exponential rise in health care costs, due to medicine’s increased efficacy, the growing number of specialties, and scientific and technological advancements, limited the average person’s access to quality care. Beatrix Hoffman points out in her new book, Health Care for Some: Rights and Rationing in the United States since 1930, that the rising cost of medical care has been one of the major reasons for the rationing of health care in the U.S., something most Americans subconsciously hate, but consciously ignore or remain silent about.
At the same time, Jolie’s op-ed reflects that the discussion about breast cancer and cancer in general, is no longer stigmatized. There was a time when cancer was a word you whispered. But in the last forty years, breast cancer patients and survivors stopped whispering. Women took a much more active role in deciding how to proceed with treatment. In these last thirty years, breast cancer has become pinkified, commercialized, and more medicalized as better detection, less evasive procedures, and preventative measures developed. In all, new medical care for breast cancer and advocacy has allowed a sense of pride, not shame, to be a part of the prevention and the treatment of breast cancer.
But as with so many other medical illnesses, breast cancer is expensive to prevent, treat, and battle. Pink Lotus, to their credit, offers uninsured women opportunities for the same treatment that Jolie and other wealthy women receive, but like so many private or public altruistic endeavors in history, there is a selection process to determine whether or not these women are deemed worthy enough to receive red carpet treatment. This very much reflects what Hoffman found in her work, that the rationing of and the right to healthcare is determined by those in power, i.e. government officials, insurance companies, and doctors, which leaves so many of those marginalized wondering if they will receive the care they need. Pink Lotus may state that all women have the right to red carpet medical care when it comes to breast cancer, but is this the reality? The answer is no, because even if you are given that right, there are many more costs than just paying for the surgeries.
Now, Jolie does mention the cost of the BRAC test (which is patented by one company), but then glossed over the rest. There is no mention of the expenses she and Brad incurred, if any. But the Jolie Treatment does not just include breast removal and reconstruction done by the best doctors. It also incorporates a massive support system. In order for all women to have the right to red carpet healthcare (which really shouldn’t all health care be red carpet?), then all women don’t just need money and insurance, but also the other resources Jolie highlighted in her op-ed, which include the supportive partner/spouse, family, an understanding employer, reliable transportation and childcare, and “time” in general. Jolie invited us to see the decisions a woman can make over her body and how powerful that can be, but at the same time, she had the opportunity and those choices because she had access to unlimited resources. I really wish she had blatantly acknowledged that her wealth and privilege allowed her to prevent a horrible disease, not weakly admit that, yes, genetic testing is expensive, and that it is hard for many women to receive proper care (but that shouldn’t stop you!).
If she is going to become a spokesperson (which maybe she is not) then she must recognize that many women in the U.S. will have neither the money nor the time and support to prevent, to battle, or even to reconstruct a region of the body with “beautiful results.” Many women must make choices on a daily basis that influence their medical well-being. The Jolie Treatment might be the red carpet medical care that every woman should have, but in reality, most will never get to walk on or down that red carpet.
 Rosemary Stevens, American Medicine and the Public Interest: A History of Specialization, 2nd ed. (Berkeley: University of California Press, 1998), 135; Beatrix Hoffman, Health Care for Some: Rights and Rationing in the United States since 1930. (Chicago: University of Chicago Press, 2012), intro.
 See Barron H. Lerner, The Breast Cancer Wars: Hope, Fear, and the Pursuit of a Cure in Twentieth-Century America. (Oxford: Oxford University Press, 2003) and Robert Aronowitz, Unnatural History: Breast Cancer and American Society. (Cambridge: Cambridge University Press, 2007).
[…] Cheryl Lemus at Nursing Clio writes about The Jolie Treatment […]
[…] Moreover, not all choices — even what might be ideal in a given circumstance — will be possible given financial constraints and lack of adequate medical coverage or support. As Cheryl Lemus, managing editor of Nursing Clio, a blog on gender and medicine, writes: […]
As a cancer survivor, I was denied reconstruction by Medicaid at the time of my surgery. Since then, it has either been too expensive, even with insurance or too difficult to find the time to recover. This has been made more difficult by at least one doctor who had no compassion or understanding of the difficulty in taking off time for recovery.
THANK YOU LESLIE. YOU ARE VERY BRAVE. I AM A LEUKEMIA SURVIVOR ALSO.
I completely agree with your article that her decision to get such extensive treatment was made possible only because of her fame and wealth. Most women do not have these options. We should be having a national conversation about that- so thanks for being one of the few people who are talking about this!
Leslie, I really feel for you!
[…] “The Jolie Treatment” By Cheryl Lemus, Nursing Clio Blog. […]
it is wasteful to discard mammary glands that aren’t yet cancer infested. they should have instead transplanted them into keira knightley.
Go away and take your unwanted and unnecessary body and medical judgments with you. Adults are talking.
Personally, I think it was a disgusting way to get not only tons of publicity, but a way to change her implants too. This woman is more than horrid.
Take the judgmental attitude toward other people’s medical decisions somewhere else. The adults are talking now.
We’ve had a few comments that have somehow slipped in that violate our commenting policy and I apologize. I have since fixed the moderation settings. If anyone needs a reminder of our policy they can view it here: https://nursingclio.org/disclaimer/
So in your world, anyone who disagrees is automatically less than worthy of expressing an opinion? I think we know who the real grownups are.
I am a Brit living in the USA who has just returned to the states after a visit with my mum in London who is going through breast cancer treatment. The truly amazing care she is receiving in state of the art facilities is incredible. Chemo, surgery and radiotherapy in a few weeks. All kinds of additional support from wig and nutrition workshops, to radical treatments that are in trial currently. But of course the most amazing part of all, is that it costs nothing. Not a penny. If we did not have the NHS in the UK, my mother would be dead. Now. The fact that in America, Americans are still under the delusion that they are the greatest country on the planet, when people can actually die from an abscessed tooth due to completely and utter lack of basic healthcare, is quite nauseating. The so called Obamacare program is also a complete misnomer. It has NO correlation to the system in the UK, absolutely none at all. But the far right keep insisting that it is the same. It. Is. Not. Private, for profit corporations have NO BUSINESS running healthcare, unless wealthy people choose to buy it. As they are free to do in the UK. However, those, and those are the majority, cannot afford to pay for it, and should not have to. We all contribute towards our Social Security and Medicare through our paychecks. Why is the idea of a portion paying for healthcare for poor people such an anathema to people who constantly proclaim their Christianity? Money, greed and the hatred of helping others without a direct cash benefit to themselves.
So well Put!! I could not agree with you more!
This nation was not built on a religion, as a matter of face every possible precaution was taken so it would never be. But it seems that the religion of “love thy neighbor as thy self” has forgotten that. They want to control everything you we do and need. Completely forgetting that to care for another as you would want to be cared for is a good thing and something to reach for.
But until those in government pry their collective heads from their nether regions we are stuck struggling and praying for help.
Shd be: “Love thy neighbor as thy stuff”
THANK YOU KERENSA FOR TELLING IT LIKE IT IS IN THIS SUPPOSELY PHONY CHRISTIAN NATION. EVERYONE SHOULD BE ANGRY ABOUT THINGS THAT REALLY MATTER. THE BRITTISH ARE MORE PROGRESSIVE AND COMPASSIONATE.
I think there are also more options for Australian women going through this than American women. It is the privatisation of medicine that ruins equality in care. Once privatised, it becomes about profiteering rather than treating the patient with the first line treatments. I hear rumblings that some public hospitals in Australia are going private and I don’t like it. I look at the fantastic NHS in the UK and then the troublesome US system and know which way I would go.
While I think the point is well made, given Jolie and Pitt’s activism around the globe, especially in poor countries, I suspect she is aware. Attention to a topic is a very important early step in changing norms.
The real problem in America is that healthcare is rationed largely by ability to pay. Perhaps the arrow above is pointed in the wrong direction? Meaning, the mere fact that she can pay or her “special status” is not a reason to be hypercritical of her effort at educating the public. Never have been a huge fan of hers but will admit undergoing something like this and then being willing to tell the public about it is pretty damn impressive.
I applaud Angelina for her proactiveness and openness regarding her disease. But, even the protocol suggested by Pink Lotus on their website for women with the BRCA1 or 2 gene is unrealistic–even if one has “good insurance.” Insurance simply will not pay for that amount of preventative imaging…every single year. So, even taking away the cost of her actual surgery and reconstruction, as well as genetic testing, time off, etc. There are even higher costs.
From the website:
“We follow a standard surveillance plan at our center for BRCA mutation carriers, which I used for Angelina:
Beginning at age 18, or 10 years younger than the youngest relative with breast cancer, every 3 months, you have breast imaging or an exam. An example plan follows:
Mammogram (wait until 25 years old)
Whole breast screening ultrasound (begin at 18)
Clinical breast exam with a breast specialist
Breast MRI, timed to menstrual cycle days 7-10 (day 1 is the day bleeding starts); Contrast Enhanced Spectral Mammography (CESM) for those who cannot have an MRI
Clinical breast exam with a breast specialist
Self breast exams (cycle days 7-10). If you don’t know how to do a self breast exam, please watch our how-to video.
For those who prefer twice-a-year surveillance, we combine the imaging with clinical breast exams, and meet every 6 months.
Ovarian surveillance begins at age 35, or 10 years prior to youngest relative with ovarian cancer, and includes the following:
Transvaginal Pelvic ultrasound every 6 months (cycle days 1-10)
CA-125 blood marker testing every 6 months (after cycle day 5)
Pelvic exam by gynecologist every 6 months”
If one is lucky enough to have insurance that will cover genetic testing… and testing is positive…and one is lucky enough to have insurance that will cover preventative mastectomy, hysterectomy, or similar…. then one almost has no choice… as no insurance will cover the amount of screening Pink Lotus recommends. Even if they do, as insurance can change so quickly, one almost must take advantage of good insurance coverage when one has it.
What’s the point of insurance if it’s not going to cover costs of preventative and/or medically necessary procedures?
While I agree, it’s important to remember that in the US, insurance companies are for-profit companies, not non-profits. Same with medicine in general–many hospitals are for-profit institutions. Insurance (at least in the US these days) is often not designed to cover every medical need, or even preventative care, but to prevent bankruptcy in case of medical disasters. It’s not uncommon to see $5,000 or higher family deductibles, which one will never meet if one’s family is healthy, but can be reached quite quickly in the case of an accident or serious illness.
That’s a nauseating amount of radiation and surveillance – I find it hard to imagine keeping that kind of schedule. Has anyone had a pelvic ultrasound? You wouldn’t want to do it every 6 months. I find it hard to believe your average insurance company would cover all of this.
If my doctor told me that a pelvic ultrasound every 6 months was a good way to catch ovarian cancer before it metastasized, I would have no hesitation in following his advice. The question of insurance coverage is, of course, another whole kettle of fish!
I have the baca1 gene.I had my first breast cancer in 1995. Had a lumpectomy, radiation and chemo.Braca testing was not an option as it was new and not paid for by medicad. I was 45. In 2008 cancer was found in my other breast.Two of my sisters also have the gene.One also had cancer twice at seperate times.After the second time her insurance paid for the test.Because of her results and 3 doctors going to bat for me I was tested and am positive.I had a double mastectomy,hysterectomy and chemo.My eldest daughter had a positive test and breast cancer.She had a double mastectomy and an oferectomy. She was 39 at the time. It has been 5 years now for me and 4 for her.